Rehabilitation Nursing: Functional Independence Measure (FIM)

TheCommuter, BSN, RN

A patient's functional capacity refers to his/her ability to carry out activities of daily living (ADLs). Unfortunately, many acute illnesses, chronic disease processes and major surgical procedures profoundly impact the patient's ability to perform ADLs. Some of these afflictions might even result in temporary or permanent disability. Rehabilitative services are valuable for restoring independence, but how does the clinician capture the burden of care with certainty? For the rehabilitation clinician, the Functional Independence Measure takes all of the guesswork out of the situation.

The Functional Independence Measure (also known as the FIM instrument) is an assessment tool used predominantly in inpatient rehabilitative settings. When properly employed, this tool determines a rehab patient's functional ability with great accuracy and gives clinicians a reliable idea of the level of assistance to provide. The FIM instrument is comprised of 18 components and is utilized in rehabilitation hospitals around the world for the healthcare team to record the true extent of patient disability.

The 18 components covered by the FIM instrument include 13 motor tasks and five cognitive assessments. The 13 motor tasks are: eating, grooming, toileting, bathing, upper body dressing, lower body dressing, bowel management, bladder management, transferring from the bed to a chair, transferring in and out of a shower area, moving up and down stairs, transferring to and from a toilet, and locomotion for walking and/or propelling a wheelchair. The five cognitive assessments are: memory, comprehension, expression, social interaction, and problem solving. Each of the 18 components is assigned a score ranging from 1 to 7. A score of 1 translates into total dependence, whereas a 7 means total independence.

Score of 1 - Total Dependence (Patient performs 0% to 24% of task)
Score of 2 - Maximal Assistance (Patient performs 25% to 49% of task)
Score of 3 - Moderate Assistance (Patient performs 50% to 74% of task)
Score of 4 - Minimal Assistance (Patient performs 75% or more of task)
Score of 5 - Setup / Supervision (Patient performs task with cueing, coaxing or setup assistance)
Score of 6 - Modified Independence (Patient performs task with assistance of a device or medication)
Score of 7 - Complete Independence (Patient performs task independently)

FIM scores are obtained nursing staff and the therapy team during the first 72 hours of the patient's stay at the rehab facility, and within 72 hours of the anticipated discharge date. The FIM instrument enables physicians, rehab nurses, physical and occupational therapy staff, and other members of the rehabilitative healthcare team to accurately measure the degree of assistance needed by the patient to perform the usual activities of daily living. In other words, the FIM instrument can capture remarkably specific proof of the burden of care when the debilitated patient is first admitted to the facility. The FIM instrument also furnishes an ongoing, standardized measurement of the patient's progress (or lack thereof) during his/her inpatient stay.

In a nutshell, the Functional Independence Measure is a significant tool in the rehabilitative healthcare setting that can accurately determine a patient's initial level of function, progress, and final outcome.

Rehabilitation Nursing: Functional Independence Measure (FIM)

About TheCommuter, BSN, RN

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